NOT YOUR NORMAL CALLS
BY JOE AMIGLIORE
Technical rescuers today have multiple advantages that were not found during rescues as little as five years ago. With the increasing demands for specialized rescue teams, manufacturers have geared up with innovative equipment. However, in confined-space rescues, trench rescues, high- angle rescues, and farm/agricultural rescues, some things are not going to change, such as the types of injuries found on these calls. These injuries present problems not normally found on the everyday EMS call. In these cases, quick thinking and a little ingenuity can save lives. First responders and technical rescue professionals alike need to constantly and consistently train to deal appropriately with these areas of injuries.
TRENCH RESCUE
Trench rescues usually involve compression-type injuries. An individual buried under 18 inches of dirt is being compressed by 2,500 to 3,000 pounds, depending on the dirt`s moisture content. Between 750 and 1,000 pounds can be concentrated directly in a four-foot square over the chest and back surface. As the dirt slowly or quickly compresses the body, the individual is unable to take a breath.
Most rescues here end up being recoveries due to the response time of properly trained and equipped trench rescue teams. However, some incidents can have a potentially happy ending, depending on the actions of first responders. Here, aggressive airway management and rapid transport are key. Multiple secondary surveys that include looking for signs such as jugular vein distention, tracheal deviation, subcutaneous emphysema, and cervical spine injuries need to be performed on the victim.
CONFINED-SPACE RESCUE
This type of rescue can host a number of different types of injuries, from blunt force trauma to inhalation problems. Here, the rescuer may be faced with a hazardous environment due to decreased oxygen levels or an increase in toxic gases due to ecological decay or hazardous materials. If a rescue is to be attempted, the following information must be obtained: oxygen levels, CO levels, the types of materials in the confined space, and the possible time frame the patient has been within the confined space. Also consider the ambient temperature. Hypothermia is not uncommon when underground, even in southern climates. All these are very important clues for determining the patient`s injuries.
In these situations, it would be wise to have a paramedic trained in hazardous materials on hand to assist with patient care. Signs and symptoms to observe for include cherry-red skin color, severe shortness of breath, abnormal skin temperature, abnormal heart rate, and lethargy. Again, rapid transport is the key to survivability. Remember: The “Golden Hour” starts when the injury occurs, not when you gain access to the patient.
HIGH-ANGLE RESCUE
This kind of rescue may be the simplest in terms of patient injury but one of the most difficult in terms of access. Where height is a consideration, rescuers must continually monitor the patient for signs of head injuries. Any fall greater than a person`s height must be treated as a potentially serious injury. Blunt force trauma has the simplest treatment modality: aggressive airway management, hyperventilation, and fluid therapy en route to a trauma facility.
Remember that shock is progressive and the initial signs may be overlooked due to the magnitude of the call. The patient may initially present with a simple long bone fracture. As the call moves into an extrication mode, the patient`s pulse rate may increase slightly and be accompanied by thirst and possibly some nausea. There is also the potential of blood loss when there is a combination of long bone fractures. A simple closed femur fracture along with a humeral fracture may result in a blood loss of up to 750 cc`s.
FARM/AGRICULTURAL RESCUE
Farm accidents can involve all of the above rescue situations. You can find it all on a farm–from disentanglements to elevated structures to confined spaces. For example, you may be called to scale a 75-foot grain silo to enter a confined space to extricate a patient trapped in grain silage. This patient may be in a flammable atmosphere with decreased oxygen levels.
Remember, do not put yourself in a situation for which you are not properly trained or equipped. Complacency will kill you! These situations may call for a pooling of local resources. Have a plan, and train with other agencies that may be able to assist with farm/agricultural rescue incidents. Predict the worst, and be ready for anything.
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So now that we have identified some of the potential injuries that you may encounter in your operations, what is the message? Train, train, train. As a child, you practiced tying your shoes; now it seems like second nature. Now you have to constantly train in various types of operations so that when the alarm sounds you will be a proactive team. Go out in your local areas and observe locations that have the potential to become incident sites. Obtain maps of your local water and sewer systems. Contact farmers for silo sizes and lists of the equipment on their farms so that there will be no delay in activating the emergency response (911). You are the key to a successful outcome for your patient–and your team. n
Special thanks to Engine Company 17 (Captain Jim Swanger, Bob Ramage, Bob Juarbe, Dave Tozzo, and Nelson Mendez) and Deputy Chief Gordon Sachs for their assistance.
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(1) This confined space is 50 feet deep. At the bottom is leeching agent about three feet deep. This agent is 200 times more dangerous than raw sewage. Can you say, “Level A”? (Photos by author.) (2) You must check your anchor points for severe rust or fractures when operating in older vertical structures. (3) How many types of rescues can be found here? How about high angle, confined space, and/or disentanglement? (4) Would a child find this small trench exciting? It is 2.5 feet deep and is running under a road that has been left unattended.
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Your local landfill will provide your team with enough “what if” scenarios to last a lifetime.
n JOE AMIGLIORE is a paramedic/firefighter and technical rescue team member with Marion County (FL) Fire-Rescue. He also serves as secretary of IAFF Local 3169, Professional Firefighters of Marion County.
